The UNM-PPP and CMS, join together to evaluate the effects of a new statewide program to enhance identification, referral and provision of care to rural families of Hispanic children with moderately severe to severe asthma. Because of New Mexico's large rural and heavily Hispanic population, it is an ideal setting to determine effective methods for case management, self-management educational programs and effective tertiary to primary care delivery collaboration. The specific aim of this project is to determine if comprehensive medical care (CMC) plus an educational self-management program for rural Hispanic children and their families will have an impact on asthma morbidity, as well as on cost and family adaptation. A randomized block design will be used with random assignment of ,subjects by county to treatment groups of 1. CMC, or standard tertiary care and education, or 2. CMC-Plus adding a structured self-management program--Open Airways/Respiro Abierto (developed and tested with support of NHLBI). CMC- Plus will also receive in home education and intervention from community based Hispanic family educators trained in an empowerment model of family intervention, in-home support, and education. Case management will be provided by CMS; CMC and CMC-Plus will be provided at the UNM-PPP in close collaboration with and transfer of care to the primary physician. Additional educational contact with primary care providers and emergency rooms will be provided through the UNM Department of Family, Community & Emergency Medicine which will utilize the National Institutes of Health National Asthma Education Program's Guidelines for Step-Wise Care of Asthma. Asthma morbidity, cost of care, family adaptation and family satisfaction will be evaluated using standardized instruments.